. 2024 Apr:17 Suppl 1:34-41.

doi: 10.1016/j.jiph.2023.04.003. Epub 2023 Apr 7.

The relationship between hand hygiene and rates of acute respiratory infections among Umrah pilgrims: A pilot randomised controlled trial

Aqel Albutti¹, Hashim A Mahdi², Ameen S Alwashmi³, Mohammad Alfelali⁴, Osamah Barasheed⁵, Elizabeth H Barnes⁶, Ramon Z Shaban⁷, Robert Booy⁸, Harunor Rashid⁹

Affiliations

¹ Department of Medical Biotechnology, College of Applied Medical Sciences, Qassim University, Buraydah 51452, Saudi Arabia. Electronic address: as.albutti@qu.edu.sa.
² National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Westmead, NSW 2145, Australia; Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia; Department of Public Health, College of Health Sciences, Saudi Electronic University, Jeddah 23442, Saudi Arabia. Electronic address: h.mahdi@seu.edu.sa.
³ Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraydah 51452, Saudi Arabia. Electronic address: aswshmy@qu.edu.sa.
⁴ Family and Community Medicine Department, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 25732, Saudi Arabia. Electronic address: malfelali@kau.edu.sa.
⁵ The Executive Administration of Research and Innovation, King Abdullah Medical City in Holy Capital (KAMC-HC), Makkah 24246, Saudi Arabia. Electronic address: barasheed.O@kamc.med.sa.
⁶ NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia. Electronic address: elizabeth.barnes@health.nsw.gov.au.
⁷ New South Wales Biocontainment Centre, New South Wales Ministry of Health, Westmead, NSW 2151, Australia; Faculty of Medicine and Health Susan Wakil School of Nursing, The University of Sydney, Sydney, NSW 2006, Australia; Public Health Unit, Centre for Population Health, Western Sydney Local Health District, North Parramatta, NSW 2151, Australia; Sydney Infectious Diseases Institute, The University of Sydney, Westmead, NSW 2145, Australia. Electronic address: ramon.shaban@sydney.edu.au.
⁸ National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Westmead, NSW 2145, Australia; Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia; Sydney Infectious Diseases Institute, The University of Sydney, Westmead, NSW 2145, Australia. Electronic address: robert.booy@health.nsw.gov.au.
⁹ National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Westmead, NSW 2145, Australia; Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia; Sydney Infectious Diseases Institute, The University of Sydney, Westmead, NSW 2145, Australia. Electronic address: harunor.rashid@health.nsw.gov.au.

PMID: 37055268
DOI: 10.1016/j.jiph.2023.04.003

Free article

The relationship between hand hygiene and rates of acute respiratory infections among Umrah pilgrims: A pilot randomised controlled trial

Aqel Albutti et al. J Infect Public Health. 2024 Apr.

Free article

. 2024 Apr:17 Suppl 1:34-41.

doi: 10.1016/j.jiph.2023.04.003. Epub 2023 Apr 7.

Authors

Aqel Albutti¹, Hashim A Mahdi², Ameen S Alwashmi³, Mohammad Alfelali⁴, Osamah Barasheed⁵, Elizabeth H Barnes⁶, Ramon Z Shaban⁷, Robert Booy⁸, Harunor Rashid⁹

Affiliations

¹ Department of Medical Biotechnology, College of Applied Medical Sciences, Qassim University, Buraydah 51452, Saudi Arabia. Electronic address: as.albutti@qu.edu.sa.
² National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Westmead, NSW 2145, Australia; Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia; Department of Public Health, College of Health Sciences, Saudi Electronic University, Jeddah 23442, Saudi Arabia. Electronic address: h.mahdi@seu.edu.sa.
³ Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraydah 51452, Saudi Arabia. Electronic address: aswshmy@qu.edu.sa.
⁴ Family and Community Medicine Department, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 25732, Saudi Arabia. Electronic address: malfelali@kau.edu.sa.
⁵ The Executive Administration of Research and Innovation, King Abdullah Medical City in Holy Capital (KAMC-HC), Makkah 24246, Saudi Arabia. Electronic address: barasheed.O@kamc.med.sa.
⁶ NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia. Electronic address: elizabeth.barnes@health.nsw.gov.au.
⁷ New South Wales Biocontainment Centre, New South Wales Ministry of Health, Westmead, NSW 2151, Australia; Faculty of Medicine and Health Susan Wakil School of Nursing, The University of Sydney, Sydney, NSW 2006, Australia; Public Health Unit, Centre for Population Health, Western Sydney Local Health District, North Parramatta, NSW 2151, Australia; Sydney Infectious Diseases Institute, The University of Sydney, Westmead, NSW 2145, Australia. Electronic address: ramon.shaban@sydney.edu.au.
⁸ National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Westmead, NSW 2145, Australia; Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia; Sydney Infectious Diseases Institute, The University of Sydney, Westmead, NSW 2145, Australia. Electronic address: robert.booy@health.nsw.gov.au.
⁹ National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Westmead, NSW 2145, Australia; Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia; Sydney Infectious Diseases Institute, The University of Sydney, Westmead, NSW 2145, Australia. Electronic address: harunor.rashid@health.nsw.gov.au.

PMID: 37055268
DOI: 10.1016/j.jiph.2023.04.003

Abstract

Background: There is a lack of randomised controlled trials (RCTs) investigating the role of hand hygiene in preventing and containing acute respiratory infections (ARIs) in mass gatherings. In this pilot RCT, we assessed the feasibility of establishing a large-scale trial to explore the relationship between practising hand hygiene and rates of ARI in Umrah pilgrimage amidst the COVID-19 pandemic.

Methods: A parallel RCT was conducted in hotels in Makkah, Saudi Arabia, between April and July 2021. Domestic adult pilgrims who consented to participate were randomised 1:1 to the intervention group who received alcohol-based hand rub (ABHR) and instructions, or to the control group who did not receive ABHR or instructions but were free to use their own supplies. Pilgrims in both groups were then followed up for seven days for ARI symptoms. The primary outcome was the difference in the proportions of syndromic ARIs among pilgrims between the randomised groups.

Results: A total of 507 (control: intervention = 267: 240) participants aged between 18 and 75 (median 34) years were randomised; 61 participants were lost to follow-up or withdrew leaving 446 participants (control: intervention = 237:209) for the primary outcome analysis; of whom 10 (2.2 %) had developed at least one respiratory symptom, three (0.7 %) had 'possible ILI' and two (0.4 %) had 'possible COVID-19'. The analysis of the primary outcome found no evidence of difference in the proportions of ARIs between the randomised groups (odds ratio 1.1 [0.3-4.0] for intervention relative to control).

Conclusion: This pilot trial suggests that conducting a future definitive RCT to assess the role of hand hygiene in the prevention of ARIs is feasible in Umrah setting amidst such a pandemic; however, outcomes from this trial are inconclusive, and such a study would need to be very large given the low rates of outcomes observed here.

Trial registration: This trial was registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) (ACTRN12622001287729), the full protocol can be accessed there.

Keywords: Acute respiratory infections; COVID-19; Hand hygiene; Mass gathering; Pilgrims; Randomised controlled trial; Umrah.

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Conflict of interest statement

Declaration of Competing Interest All authors declare no conflict of interest.

Cited by

Epidemiological Differences in Hajj-Acquired Airborne Infections in Pilgrims Arriving from Low and Middle-Income versus High-Income Countries: A Systematised Review.
Mahdi HA, Alluhidan M, Almohammed AB, Alfelali M, Shaban RZ, Booy R, Rashid H. Mahdi HA, et al. Trop Med Infect Dis. 2023 Aug 17;8(8):418. doi: 10.3390/tropicalmed8080418. Trop Med Infect Dis. 2023. PMID: 37624356 Free PMC article. Review.
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The relationship between hand hygiene and rates of acute respiratory infections among Umrah pilgrims: A pilot randomised controlled trial

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The relationship between hand hygiene and rates of acute respiratory infections among Umrah pilgrims: A pilot randomised controlled trial

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